Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Abstract

Portal hypertension is a serious complication of chronic liver disease. Varices are the most common clinical manifestations though their prevalence is extremely variable, ranging from 24% to 80% [1,2]. This wide range seems to be related to the degree of liver dysfunction: compensated patients show a lower prevalence than decompensated ones. Bleeding from ruptured varices is the predominant cause of mortality in patients with portal hypertension, and they represent the cause of death in about one third of cirrhotic subjects [3,4]. The most common site of varices is the lower esophagus, but they may occur at any location where there are portosystemic anastomoses [5,6], like the rectum, the peritoneum, the right diaphragm, the falciform and splenic ligaments, and the umbilicus. Any nongastroesophageal site is referred to as an "ectopic varix" [7,8]. Periumbilical varices are known as "caput medusae." Bleeding from ectopic varices represents only 1-5% of all variceal bleeding [9,10]: more specifically, exsanguination from caput medusae is